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      Comprehensive review on rhino-neurosurgery

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          Abstract

          In the past 2 decades, an innovative and active field of surgical collaboration has been evolved and established combining the expertise of neurosurgery and rhinosurgery in the endonasal treatment of different lesions affecting the anterior skull base together with the adjacent intranasal and intradural areas. Important prerequisites for this development were improvements of technical devices, definitions of transnasal surgical corridors, and approvements in endonasal reconstructions, e.g. by use of pedicled nasal mucosal flaps. Due to these improvements, the rate of perioperative infectious complications remained acceptable. Interdisciplinary surgical teams (4-hands-2-minds) have been established constituting specialized centers of “rhino-neurosurgery”. With growing expertise of these groups, it could be shown that oncological results and perioperative complications were comparable to traditional surgery while at the same time the patients’ morbidity could be reduced.

          The present review encompasses the recent literature focusing on the development, technical details, results, and complications of “rhino-neurosurgery”.

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          The recurrence of intracranial meningiomas after surgical treatment.

          D. Simpson (1957)
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            Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings.

            We present 25 pituitary adenomas that were confirmed surgically to have invaded the cavernous sinus space. The surgical results are compared with the preoperative magnetic resonance imaging findings. For comparable radiological criteria, we classified parasellar growth into five grades. This proposed classification is based on coronal sections of unenhanced and gadolinium diethylene-triamine-pentaacetic acid enhanced magnetic resonance imaging scans, with the readily detectable internal carotid artery serving as the radiological landmark. The anatomical, radiological, and surgical conditions of each grade are considered. Grades 0, 1, 2, and 3 are distinguished from each other by a medial tangent, the intercarotid line--through the cross-sectional centers--and a lateral tangent on the intra- and supracavernous internal carotid arteries. Grade 0 represents the normal condition, and Grade 4 corresponds to the total encasement of the intracavernous carotid artery. According to this classification, surgically proven invasion of the cavernous sinus space was present in all Grade 4 and Grade 3 cases and in all but one of the Grade 2 cases; no invasion was present in Grade 0 and Grade 1 cases. Therefore, the critical area where invasion of the cavernous sinus space becomes very likely and can be proven surgically is located between the intercarotid line and the lateral tangent, which is represented by our Grade 2. We also measured tumor growth rates, using the monoclonal antibody KI-67, which shows a statistically higher proliferation rate (P < 0.001) in adenomas with surgically observed invasion into the cavernous sinus space, as compared with noninvasive adenomas.
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              A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap.

              In patients with large dural defects of the anterior and ventral skull base after endonasal skull base surgery, there is a significant risk of a postoperative cerebrospinal fluid leak after reconstruction. Reconstruction with vascularized tissue is desirable to facilitate rapid healing, especially in irradiated patients. We developed a neurovascular pedicled flap of the nasal septum mucoperiosteum and mucoperichondrium based on the nasoseptal artery, a branch of the posterior septal artery (Hadad-Bassagasteguy flap [HBF]). A retrospective review of patients undergoing endonasal skull base surgery at the University of Rosario, Argentina, and the University of Pittsburgh Medical Center was performed to identify patients who were reconstructed with a vascularized septal mucosal flap. Forty-three patients undergoing endonasal cranial base surgery were repaired with the septal mucosal flap. Two patients with postoperative cerebrospinal fluid leaks (5%) were successfully treated with focal fat grafts. We encountered no infectious or wound complications in this series of patients. One patient experienced a posterior nose bleed from the posterior nasal artery. This was controlled with electrocautery and the flap blood supply was preserved. The HBF is a versatile and reliable reconstructive technique for defects of the anterior, middle, clival, and parasellar skull base. Its use has resulted in a sharp decrease in the incidence of postoperative cerebrospinal fluid leaks after endonasal skull base surgery and is recommended for the reconstruction of large dural defects and when postoperative radiation therapy is anticipated.

                Author and article information

                Journal
                GMS Curr Top Otorhinolaryngol Head Neck Surg
                GMS Curr Top Otorhinolaryngol Head Neck Surg
                GMS Curr Top Otorhinolaryngol Head Neck Surg
                GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery
                German Medical Science GMS Publishing House
                1865-1011
                22 December 2015
                2015
                : 14
                : Doc01
                Affiliations
                [1 ]Department of Otolaryngology, Head & Neck Surgery, University Medicine Greifswald, Germany
                [2 ]Department of Neurosurgery, University Medicine Greifswald, Germany
                Author notes
                *To whom correspondence should be addressed: Werner Hosemann, Department of Otolaryngology, Head & Neck Surgery, University Medicine Greifswald, Walther-Rathenau-Str. 43-45, 17475 Greifswald, E-mail: hosemann@ 123456uni-greifswald.de
                Article
                cto000116 Doc01 urn:nbn:de:0183-cto0001164
                10.3205/cto000116
                4702051
                26770276
                0815602b-075b-462d-a23f-a0783cee8618
                Copyright © 2015 Hosemann et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Share Alike 4.0 License.

                History
                Categories
                Article

                Surgery
                skull base surgery,rhino-neurosurgery,endoscopic endonasal sinus surgery
                Surgery
                skull base surgery, rhino-neurosurgery, endoscopic endonasal sinus surgery

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